Author(s): Sreevidhya T.M, James D Raj


DOI: 10.5958/0974-360X.2015.00283.8   

Address: Sreevidhya T.M, Dr. James D Raj
Third Year BDS Student, Department of Conservative and Endodontics, Saveetha Dental College 162, Poonamalee High Road, Vellapanchavadi, Chennai-77, Tamil Nadu.
MDS, Department of Conservative and Endodontics 162, Saveetha Denatal College, Poonamalee High Road, Vellapanchavadi, Chennai-77, Tamil Nadu.
Corresponding Author

Published In:   Volume - 8,      Issue - 11,     Year - 2015

The inter-appointment flare may be defined as the occurrence of severe pain and swelling or both within few hours or days following endodontic treatment appointment, requiring an unscheduled visit. The current endodontic treatment is supposed to be a pain free during the procedure but still the patient may encounter the pain after the appointment. Although some patients may experience mild moderate pain some patients may end up with the flare up. The causative factors of inter appointment pain encompass mechanical, chemical, and/or microbial injury to the pulp or per iradicular tissues. Microorganisms can participate in causation of inter appointment pain in the following situations apical extrusion of debris; incomplete instrumentation leading to changes in the endodontic microbiota or in environmental conditions; and secondary intra radicular infections. This article is a review on the microbial cause and reason for the sudden inter-appointment flare up and steps to manage and prevent them.

Cite this article:
Sreevidhya T.M, James D Raj. Microbial Causes of Inter Appointment Flare Up – Review. Research J. Pharm. and Tech. 8(11): Nov., 2015; Page 1588-1592. doi: 10.5958/0974-360X.2015.00283.8

Sreevidhya T.M, James D Raj. Microbial Causes of Inter Appointment Flare Up – Review. Research J. Pharm. and Tech. 8(11): Nov., 2015; Page 1588-1592. doi: 10.5958/0974-360X.2015.00283.8   Available on:


1      Walton R, Fouad A. Endodontic interappointment flare- ups. a prospective study of incidence and related factors. J Endod 1992: 18: 172–177.

2      Selye H. The partof  inflammation in the local adaptation syndrome. In: Jasmine G, Robert A. eds.The mechanism of inflammation. Acta Montreal1953; 53-74.

3      P.Carrotte.Endodontic Part 3. Treatment endodontic emergencies BDJ .2004; 197:299-305.of endodontic emergenies. BDJ 2004; 197:299-305

4      Samuel Seltzer, Irving J. Naidorf . Flareups  in endodontics.1 Etiological factors. J Endod .2004; 30:476-481.

5      Dean Baugh, James Wallace, The role of apical instrumentation in root canal treatment: A review of the literature, Journal of Endodontology, 31(5), 2005, 333-340.

6      J.F.Siqueira Jr, Aetiology of root canal treatment failure: why well-treated teeth can fail, International endodontic journal, (34), 2001, 1-10.

7      Lin LM, Pascon EA, Skribner J, Gaengler P, Langeland K. 1991, Clinical, radiographic and histopathological study of endodontic treatment failures, Oral surg oral medicine oral pathology oral radiology and endodontics, (71), 603-611.

8      Siqueira JF Jr, Uzeda M, Fonseca MEL. 1996, Scanning electron microscopic evaluation of in vitro dentinal tubules penetration by selected anaerobic bacteria, Journal of Endodontology, (22), 308-10.

9      Fabricius L, Dahlen G, Ohman AE, Moller AJR, predominant indigenous oral bacteria isolated from infected root canals after varied times of closure, Scandinavian journal of dental research, (90), 1982, 134-144.

10   J.F.Siqueira Jr, microbial causes of endodontic flare-ups, International endodontic journal, (36), 2003, 453-463.

11   Selye H, The part of inflammation in the local adaptation syndrome. In: Jasmin G, Robert A, eds.The mechanism of inflammation, Acta Montreal, 1953, 53-74.

12   Samuel Seltzer, Irving J.Naidorf, Flare-ups in endodontics: I. Etiological factors, Journal of endodontics, 30(7), 2004, 476-481.

13   Sundqvist G, Bacteriological studies of necrotic dental pulps (dissertation) Umea, Sweden. 1976. 24-27

14   Luis Eduardo Chavez de Paz Villanueva, Fusobacterium nucleatum in endodontic flare-ups, Oral surgery oral medicine oral pathology oral radiology and endodontology, 93(2), 2002, 179-183.

15   Guven Kayaoglu, Dag Orstavik. Virulence factors of Enterococcus faecalis: relationship to endodontic disease. Crit. Rev. Oral. Biol. Med. 2004; 15 (5): 308 – 320.

16   Isabela N R, Jose FS, Katia RNS Association of Enterococcus faecalis with different forms of periradicular diseases. J Endodon. 2004; 30(5): 315 -320.

17   Charles H.Stuart, Scott A.Schwartz, Thomas J.Beeson, Christopher Owatz, Enterococcus faecalis: its role in root canal treatment failure and current concepts in retreatment, Journal of endodontology, (32),2006, 93-98.

18   Rocas IN, Siqueira JF, Santos KRN, Association of Enterococcus faecalis with different forms of periradicular diseases, Journal of endodontology, (30), 2004, 315-320.

19   Mundy LM, Sahm DF, Gilmore M. Relationships between Enterococcal virulence and antimicrobial resistance. Clin. Microbiol.Rev.2000; 13(4): 513 – 522.

20   Grifee M, Patterson SS, Miller CH, Kafawry AH, Newton GW, The relationship of Bacteroides melaninogenicus to symptoms associated with pulpal necrosis, Oral surgery, (50), 1980, 457-461.

21   Glossary: Contemporary Terminology for Endodontics.6th ed. Chicago, IL: American association of Endodontists; 1998.

22   Rosenberg PA.Clinical strategies for managing endodontic pain. Endod Top.2002; 3:78–92.

23   Chestner SB, Selman AJ, Friedman J, Heyman RA. Apical fenestration: Solution to recalcitrant pain in root canal therapy. J Am Dent Assoc. 1968; 77:846–8.  [PubMed]

24   Peters DD. Evaluation of prophylactic alveolar trephination to avoid pain. J Endod. 1980; 6:18–526.[PubMed]

25   Nist E, Reader A, Beck M. Effect of apical trephination on postoperative pain and swelling in symptomatic necrotic teeth. J Endod.2001; 27:415–20.  [PubMed]

26   Trope M. Relationship of intracanal medicaments to endodontic flare-ups. EndodDent Traumatol.1990; 6:226–9.  [PubMed]

27   Fouad AF. Are antibiotics effective for endodontic pain? Endod Top.2002; 3:52–6.

28   Hargreaves KM, Seltzer S. Pharmacological control of dental pain. In: Hargreaves KM, Goodis E, editors. Seltzer and Bender's Dental Pulp. Chicago: Quintessence; 2002. pp. 205–26.

29   Keiser K, Hargreaves KM. Building effective strategies for the management of endodontic pain. Endod Top.2002; 3:93–105.

30   Holstein A, Hargreaves KM, Niederman R. Evaluation of NSAID's for treating post-endodontic pain. A systematic review. Endod Top.2002; 3:3–13.

31   Wright CE, 3rd, Antal EJ, Gillespie WR, Albert KS.Ibuprofen and acetaminophen kinetics when taken concurrently. Clin Pharmacol Ther.1983; 34:707–10. [PubMed]

32   Breivik EK, Barkvoll P, Skovlund E. Combining diclofenac with acetaminophen or acetaminophen-codeine after oral surgery: A randomized, double-blind single dose study. Clin Pharmacol Ther.1999; 66: 625–35.  [PubMed]

33   Wideman GL, Keffer M, Morris E, Doyle RT, Jr, Jiang JG, Beaver WT. Analgesic efficacy of a combination of hydrocodone with ibuprofen in postoperative pain. Clin Pharmacol Ther. 1999;65:66–76.  [PubMed]

Recomonded Articles:

Research Journal of Pharmacy and Technology (RJPT) is an international, peer-reviewed, multidisciplinary journal.... Read more >>>

RNI: CHHENG00387/33/1/2008-TC                     
DOI: 10.5958/0974-360X 

56th percentile
Powered by  Scopus

SCImago Journal & Country Rank

Recent Articles


Not Available